Drawing Blood From PICC Lines

[rileygrl11]

I work on an Oncology unit where many pts have PICC lines. there are 3 drs that routinely start them for us. These drs say that we are not to use them to draw blood for labs. They have said that this will cause the line to collapse. At my hospital, the RN has to do lab draws from central lines/PICCS. Some RN's abide by this and have lab stick the patient for labs. Other RN's draw blood from the PICC reason being,....they don't have any veins to begin with (which is why they have the PICC). I would like to get your opinion on this. I am a fairly new grad and have made waves with this. I used to draw blood from them until I learned the drs said not to. So now I refuse to do it and have lab do it (often times they are unable to get enough blood or can't find a good vein). Just curious. Thanks!

[BBFRN, BSN, PhD]

NurseKrissy said:

We draw from PICCs all the time, you just can't use a syringe bigger than 3cc.

You might want to check on that. It's standard protocol to use 10cc syringes for PICC draws and flushes.

[oldiebutgoodie, RN]

At my hospital, we draw blood from PICCs all the time. However, the nurses who place the PICC (we have a special team who do it) post a notice over the patient's bed with instructions on blood draw, including,

1. Use 10 CC syringe for flushing (don't remember if there was a recommendation for drawing)

2. Flush with 20 CC after finishing with draw

Oldiebutgoodie

[antsypantsy]

(preface: I'm applying to nursing schools because of my experiences as a patient)

I have had maybe 6 different PICC lines in my arms over the course of 3 yrs, as well as a Hickman catheter. No one in all that time was ever brave enough to try it with me-- and I certainly wish they had!! My veins in my right arm (left was preferred for the PICCs) got harder and harder to find after getting blood drawn every week. This was about 19 yrs ago, frm when I was 15-18.

Also want to say that you lovely PICC people are the reason I want to be a nurse-- you're all the best!! Seriously, I got muuuuuch better care from nurses than from doctors.

ps I had Lyme Carditis. It was an interesting life experience, to say the least...:rotfl:

[SFCardiacRN]

A 3cc syringe creates more pressure than a 10cc. Hard to believe but true. I would be very careful when going against a Dr's orders. You better be sure you are unquestionably right.

[steelcityrn, RN]

picc lines can be very fragile for lab specimens because alot has to do with narrowing of the line and the valves. I always try them first but if its running slow, its venipuncture time.

[nbnurse95]

At our hospital it's very rare for a dr to allow blood to be drawn from a PICC.

[Alexsys]

Jay-Jay said:

Why not? The reason isn't obvious to me! I would think you would not want to do a peripheral draw on a pt. receiving heparin, because they are much more likely to bleed from the puncture site and get a hematoma!

Of course, you would have to disconnect the drip to do the draw, flush pre and post, then reconnect. That would keep the heparin from contaminating the sample(s) drawn.

In the community we use heparin for 2 things 1) Hepalean is used to flush central lines (usually 10 cc NS, then 3 cc Hepalean) and 2) Fragmin (low molecular wt. heparin) is given to pts. with DVT's by s.c. injection. We don't do heparin drips, so maybe there's something I don't know here....

This is how we do it at my facility as well. I would have a peripheral stick done in the case the coag check was not WNL from being drawn from the PICC. A picc line could last a while if it is maintained properly(i.e. flushing and flushing technique) and if the nurse drawing blood from the picc does not draw too fast--pulling too fast if the number 1 problem with hemolyzed blood draws.

To the poster that has bigger fish to fry, I would think that advocating for your patient's well being would have been one of those fish. I would be a bit iffy on having my patient on heparin have their labs drawn peripherally. Especially if they have many timed study labs throughout the shift. to many risks with bleed out and hematoma development. But on the other hand sometimes the MDs would have good reason for their decisions though. But I would want to know.

[nightengale0]

Just wondering the rationale for flushing before blood draw on PICC. Our policy is waste 5cc, get specimen, then flush (20cc ns, 3cc heparin), no flush prior. Thanks!

[morte, LPN, LVN]

nightengale0 said:

Just wondering the rationale for flushing before blood draw on PICC. Our policy is waste 5cc, get specimen, then flush (20cc ns, 3cc heparin), no flush prior. Thanks!

if you are in a no "heparin" institution, prob makes sense.....the pre flush would be to clear any residual drug from the cath...

[NurseRatched67]

I work in outpatient Oncology.

We change dressings on PICC lines and draw labs using nothing smaller then a 10cc syringe.

We flush with NS 5-6ml, then drawback and waste 5ml-6ml, then switch syringe and draw labs. We put vacutainer device on draw syringe, not on PICC port directly. You want to limit pressure on vital, small lines.

We put new extensions on for our patients (because they go home and flush their own lines daily!), flush with NS and heparin.

The only time we would not draw from a certain lumen of a PICC is if it is being used for TPN. Our patients usually come in with double lumen Hickman lines so we only draw off the lumen not being used for TPN.

Again, that is in an outpatient setting. What is done as an inpatient may be different.

[gmsr]

It looks like it has been a while since this has been discussed.

I have been reading the old posts and have a question.

I am new to home health and need to draw blood on an adult from a PICC line:

would I be better to use a 10cc syringe, flush with saline, draw waste, draw sample, flush with saline, flush with heparin OR attach a butterfly to the PICC port and attach the tubes to fill?

Thank you.

[berrylion]

Flush with 10cc n/saline

I then pull back on the same syringe and discard 10cc

Collect sample

Flush with 10cc n/saline x 2.

Thats what I do in the hospital, we dont use heparin. Might be different for home health